Öztürk Sonay Kuş, Erden Esra
Department of Surgical Pathology, Ankara University, School of Medicine, Ankara, Turkey.
Turk Patoloji Derg. 2018;34(2):127-133. doi: 10.5146/tjpath.2017.01414.
Pancreatic ductal adenocarcinoma is an aggressive tumor with short survival. In this study we aimed to investigate the effect of well-known prognostic parameters on survival in these tumors.
A total of 56 pancreatic ductal adenocarcinoma cases diagnosed between 2005 and 2014 were included in the study. Survival data were obtained and histopathological parameters were re-evaluated in each patient.
Tumor size (p=0.029), mitotic count (p=0.030), lymph node metastasis (p=0.003), metastatic lymph node ratio (p < 0.001) and ampullary invasion (p=0.044) had a statistically significant relationship with survival. However, there was no relationship between survival and tumor grade, lymphovascular and perineural invasion, and peripancreatic soft tissue invasion.
Our results showed that existent 2010 WHO pancreatic ductal adenocarcinoma grading parameters excluding mitotic count are subjective and not applicable. Considering that almost all of the tumors in our series were larger than 2 cm, we think that the 2 cm cut-off in tumor size is insufficient to make the tumor stage pT2. Peripancreatic soft tissue invasion, which is a common finding in pancreatic ductal adenocarcinoma, should also not be assessed like adjacent tissue invasion and make the tumor reach pT3 stage independent of tumor size. It is clear that the existent WHO tumor grading and pT staging parameters need to be revised and the mitotic count, which correlates with survival, should be presented in pathology reports.
胰腺导管腺癌是一种侵袭性肿瘤，生存率低。在本研究中，我们旨在调查这些肿瘤中已知预后参数对生存的影响。
本研究纳入了2005年至2014年间诊断的56例胰腺导管腺癌病例。获取生存数据，并对每位患者的组织病理学参数进行重新评估。
肿瘤大小（p = 0.029）、有丝分裂计数（p = 0.030）、淋巴结转移（p = 0.003）、转移淋巴结比例（p < 0.001）和壶腹侵犯（p = 0.044）与生存具有统计学显著关系。然而，生存与肿瘤分级、淋巴管和神经周围侵犯以及胰腺周围软组织侵犯之间没有关系。
我们的结果表明，现行的2010年世界卫生组织胰腺导管腺癌分级参数（不包括有丝分裂计数）具有主观性且不适用。考虑到我们系列中的几乎所有肿瘤都大于2 cm，我们认为肿瘤大小2 cm的临界值不足以使肿瘤分期为pT2。胰腺导管腺癌中常见的胰腺周围软组织侵犯，也不应像评估相邻组织侵犯那样进行评估，且不应使肿瘤独立于肿瘤大小而达到pT3期。显然，现行的世界卫生组织肿瘤分级和pT分期参数需要修订，与生存相关的有丝分裂计数应在病理报告中呈现。
